Faculty of Medicine, Department of Internal Medicine, Division of Intensive Care, Düzce University, Düzce, Turkey.
Faculty of Medicine, Department of Internal Medicine, Düzce University, Düzce, Turkey.
Clin Respir J. 2021 Sep;15(9):973-982. doi: 10.1111/crj.13401. Epub 2021 Jun 4.
Average volume-assured pressure support (AVAPS), a dual mode, delivers a set tidal volume (TV) per kg by adjusting the pressure between upper and lower inspiratory positive airway pressures (IPAP). Thus, ventilation is presumed to be happened effectively by sending a guaranteed TV. This study was aimed to evaluate the effectiveness of AVAPS mode in critically ill patients with acute hypercarbic respiratory failure (HRF) and compare the results with bilevel positive airway pressure-spontaneous/timed (BPAP-S/T) mode.
Sixty patients were assigned to BPAP-S/T (n = 29) and AVAPS modes (n = 31). Maximum IPAP was started at 20 cmH O and minimum IPAP was set at 5 cmH O higher than expiratory positive airway pressure (EPAP) in AVAPS mode. IPAP was started at 15 cmH O in BPAP-S/T mode. IPAP levels were titrated up to 30 cmH O during noninvasive mechanic ventilation (NIMV) with a targeted TV of 6-8 mL/kg. Patients were followed for 5 days.
No differences were found in pH, paCO , HCO , TV and EPAP between the two groups when compared separately by days. Maximum IPAP levels were significantly high in AVAPS mode in all times (P < 0.001). The length of stay (LOS) in intensive care unit (ICU) (P = 0.994) and hospital (P = 0.509), hours of NIMV use per day (P = 0.101) and NIMV success rate (P = 0.931) were identical between the two groups. ICU (P = 0.931), hospital (P = 0.800), 6-month (P = 0.919) and 1-year (P = 0.645) mortality rates were also not different between the both groups.
AVAPS mode had similar efficiency with BPAP-S/T mode regarding the NIMV treatment success in critically ill patients with acute HRF.
平均容量保证压力支持（AVAPS）是一种双模式，通过调整上、下吸气正压气道压力（IPAP）之间的压力，为每公斤设定潮气量（TV）。因此，通过发送保证 TV，认为通气能够得到有效实现。本研究旨在评估 AVAPS 模式在急性高碳酸血症性呼吸衰竭（HRF）危重症患者中的有效性，并将结果与双水平气道正压通气-自主/定时（BPAP-S/T）模式进行比较。
将 60 例患者分为 BPAP-S/T 组（n=29）和 AVAPS 组（n=31）。在 AVAPS 模式中，最大 IPAP 起始于 20cmH₂O，最小 IPAP 设置为高于呼气正压气道压力（EPAP）5cmH₂O。BPAP-S/T 模式中，起始 IPAP 为 15cmH₂O。在无创机械通气（NIMV）过程中，将 IPAP 滴定至 30cmH₂O，目标 TV 为 6-8mL/kg。对患者进行为期 5 天的随访。
与单独按天数比较时，两组间 pH、paCO₂、HCO₃⁻、TV 和 EPAP 无差异。在所有时间点，AVAPS 模式的最大 IPAP 水平均显著升高（P<0.001）。两组间 ICU 住院时间（P=0.994）和医院住院时间（P=0.509）、每天 NIMV 使用时间（P=0.101）和 NIMV 成功率（P=0.931）相同。两组间 ICU（P=0.931）、医院（P=0.800）、6 个月（P=0.919）和 1 年（P=0.645）死亡率也无差异。
AVAPS 模式与 BPAP-S/T 模式在急性 HRF 危重症患者的 NIMV 治疗成功率方面具有相似的效果。
